Epidemiologic trends in the evaluation and treatment of lower urinary tract symptoms in elderly male Medicare patients from 1991 to 1995

Purpose: We describe utilization of procedures to reveal recent epidemiologic trends in evaluation and management of benign prostatic hyperplasia (BPH). Materials and Methods: Medicare claims data reflect clinical practice in the vast majority of elderly Americans. The standard 5% beneficiary sample from Medicare claims files for 1991 to 1995 was searched to identify men 65 years old or older with invoices containing diagnostic and procedure codes indicative of prostate disease or lower urinary tract symptoms. Physician/supplier file claims for this sample of patients were used to identify diagnostic and therapeutic procedures relevant to BPH. Results: During these 5 years claims for uroflowmetry peaked in 1993, filling cystometry gradually declined and pressure flow studies increased. Transurethral resection of the prostate decreased 43%, with even steeper reductions for open prostatectomy. The proportion of transurethral resections performed in hospital inpatients ebbed from 96 to 88%. Age specific operative rates for transurethral resection were highest in the ninth decade, and during the 5 years operative rates generally declined more among white than black men of the same age. Although urethrocystoscopy and excretory urography explicitly for BPH decreased markedly, from 1992 to 1995 the proportion of transurethral resections preceded by urethrocystoscopy for any indication increased from 45 to 47%, while excretory urograms were still obtained before 36% of these operations in 1992 and decreased to 26% in 1995. Conclusions: Evaluation and treatment of lower urinary tract symptoms in elderly men in the United States changed rapidly between 1991 and 1995, with a sharp decline in invasive therapy for BPH.